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Acute Viral Hepatitis



This is the term referring to inflammation of the liver, which may result from various causes, both infectious i.e. viral, bacterial, fungal, and parasitic organisms and noninfectious e.g. alcohol, drugs, autoimmune and metabolic diseases; this section focuses on viral hepatitis and its sequels.

Acute Viral Hepatitis is a systemic infection predominantly affecting the liver caused hepatotropic viral agents namely Hepatitis A virus (HAV), Hepatitis B virus (HBV), Hepatitis C virus (HCV),HBV – associated delta agent or Hepatitis D virus (HDV), and Hepatitis E virus (HEV);in most cases  leads to a self limiting  disease but can take a fulminant course and lead to hepatic failure.  


Diagnostic Criteria

  • Fever, anorexia, malaise, jaundice and abdominal pain 

  • Enlarged   and tender liver 

  • Altered consciousness, coma (hepatic encephalopathy), and bleeding stigmata (in fulminant cases). Plus

  • Serological evidence of specific viral antigen/ core antibody tests (HBc IgM or HBc IgG); and biochemical alteration of liver tranaminases (ALT, AST).     




  • There is no specific treatment to alter the course of acute viral hepatitis.

  • Supportive management including hydration, feeding, control fever and pain if present is required.

  • Fulminant cases may require specific antiviral medications


Note: Refer all suspected and confirmed cases to next level of care with adequate expertise and facility for proper management and disposal.


Chronic viral Hepatitis




This is a chronic inflammatory reaction that on going beyond 6months from the acute infection. Most common causative agents are HBV, HCV, and HDV which potentially leads to liver fibrosis, cirrhosis and portal hypertension, hepatocellular carcinoma and hepatic failure. 


Diagnostic Criteria 

  • Usually asymptomatic 

  • Right upper quadrant abdominal pains. 

  • Fatigue, malaise, anorexia, low grade fever; jaundice is frequent in severe disease. 

  • Ascites, variceal bleeding, encephalopathy, coagulopathy, and hypersplenism.

  • Uticaria, athritis, vasculitis, polyneuropathy, glomerulonephritis, thyroditis PLUS

  • Serological evidence of specific viral antigen/ core antibodies and quantitative PCR assays. 


Pharmacological Treatment 


For HBV     

  • Tenofovir (PO) 300mg once daily for life


  • Entecavir (PO) 0.5mg–1mg once daily for life 


  • Lamuvidine (PO) 100mg once daily for life  



  • Ledpasvir 90mg in divided doses (PO) for 12–24 weeks


  • Sufosbuvir 400mg in divided doses (PO) for 12–24 weeks


  • Ribavirin 600mg–1000mg in divided doses (PO) for 12–24 weeks  


Note:  Refer cases to the next level care with adequate expertise and facility for proper management 

Updated on, 2.11.2020


1. STG

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